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NPI Code Detail

MEDICARE: LEONID MIRSON MD

MEDICARE: LEONID MIRSON MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1205455144
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEONID MIRSON MD
Provider Business Mailing Address
First Line : 330 MOUNT AUBURN ST
Second Line :
City : CAMBRIDGE
State : MA
Zip : 02138-5597
Country : US
Telephone Number : 617-492-3500
Fax Number :
Provider Business Practice Location Address
First Line : 330 MOUNT AUBURN ST
Second Line :
City : CAMBRIDGE
State : MA
Zip : 02138-5597
Country : US
Telephone Number : 617-492-3500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2020
Last Update Date : 06/01/2026

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Directions to “ LEONID MIRSON MD” Practice Location

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